[Cardiac rehabilitation in the Ile-de-France region. Current organization and suggestions for reorganization]. / Réadaptation cardiaque en Ile-de-France. Etat de l'organisation actuelle et propositions d'aménagement.

The Ile-de-France Regional Hospital Agency wished to complete the Regional Health Organisation Plan for Cardiology from 1999-2004 with a specific report on cardiac rehabilitation. A working group was set up and, after 8 meetings, its conclusions were submitted. They were adopted after presentation to the regional technical committee for cardiology. The requirements for cardiac rehabilitation were defined according to acknowledged indications in the medical literature: about 18,000 patients per year are candidates for cardiac rehabilitation in the Ile de France region. The existing equipment (1999-2000) was reviewed: 435 hospital beds allowing treatment of 5,780 patients per year; 45 day hospital places (only 20 of which were operational in 2000), in addition to a large fee for act activity allowing a total ambulatory management of a further 1,265 patients per year. The following proposals were made: more uniform distribution of hospital beds in the region; develop ambulatory rehabilitation especially on a day hospital basis; create a third possibility of rehabilitation associating home exercise rehabilitation and a program of education, prevention, reinsertion, psychotherapy within a network of extra-hospital care.

[Are sanitation services complaints an indicator of quality of care?]. / Les plaintes sanitaires sont-elles un indicateur de qualité des soins?

A retrospective analysis of 211 consecutive complaints treated at the Direction of Health and Social Assistance of Paris was undertaken in order to specify the nature of the complaints and to evaluate their pertinence as an indicator of quality of care. The majority of complaints concern public and private health establishments, in particular surgery and psychiatric services. Although the study confirms the dysfunctioning of the organisation of services and also of therapeutic methods and medical treatments, the evaluation of iatrogenic risks and their avoidable nature is difficult and requires precise instruction. Complaints seem to be a neglected indicator of quality, yet they concern information that is accessible and could, if used with other information, be a first milestone in the vigilance of medical treatments.